18 JAN 2017 2030 IM

Question 1

Bleeding episodes and severe ISOLATED thrombocytopenia with normal hematocrit and leukocyte count – diagnosis?

Answer 1

(idiopathic) ITP

Question 2

Fever, microangiopathic hemolytic anemia, thrombocytopenia with NONpalpable purpura, kidney injury, neurologic findings – diagnosis?

Answer 2

Thrombotic thrombocytopenic purpura (decreased ADAMTS13 activity)

Question 3

TTP is due to a decrease in what protein?

Answer 3

ADAMTS13

Question 4

What is a main side effect of CCBs? Which type specifically? What is the MOA?

Answer 4

• peripheral edema
• dihydropyridine (amlodipine, nifedipine)
• preferential dilation of precapillary vessels (arteriolar dilation) leading to increased hydrostatic pressure and fluid extravasation into the interstitium

Question 5

What can be given to ameliorate the peripheral edema side effects of CCBs?

Answer 5

ACE inhibitors – cause post-capillary venodilation and can normalize the increased capillary hydrostatic pressure caused by the CCBs

Question 6

What is Trousseau’s syndrome? What is it associated with?

Answer 6

• Hypercoagulability disorder presenting with recurrent and migratory superficial thrombophlebitis at unusual sites (arm, chest)
• associated with an occult visceral malignancy

Question 7

Damage to the cortico-cortical fibers leads to what type of gait abnormality?

Answer 7

Gait apraxia (Bruns ataxia) – magnetic gait (difficulty initiating forward movement of the feet when they are on the ground)

Question 8

Gait apraxia (Bruns ataxia) – magnetic gait (difficulty initiating forward movement of the feet when they are on the ground – is caused by damage to what area of the brain?

Answer 8

Cortico-cortical fibers

Question 9

Atrial fib in a patient with WPW who is hemodynamically unstable – treatment?

Answer 9

Immediate electrical cardioversion

Question 10

Atrial fib in a patient with WPW who is hemodynamically stable – treatment?

Answer 10

• procainamide or ibutilide

- Goal is to control ventricular response and terminate atrial fib

Question 11

What are side effects of EPO therapy?

Answer 11

• worsening of HTN
• headaches
• flu like symptoms
• red cell aplasia

Question 12

What is multiple system atrophy (Shy-Drager syndrome)?

Answer 12

Degenerative disease characterized by:

• parkinsonism
• autonomic dysfunction
• widespread neuro signs

Question 13

What should be considered in a patient with Parkinsonism experiencing orthostatic hypotension, impotence, incontinence, or other autonomic symptoms?

Answer 13

Multiple system atrophy (Shy-Drager syndrome)

Question 14

What is the most common cause of corneal blindness in the US?

Answer 14

HSV infection of the eye

Question 15

Symptoms: keratitis, conjunctivitis with eye pain, rapidly progressive visual loss and bilateral retinal necrosis

Fundoscopy: widespread pale, peripheral lesions and central necrosis of the retina

Answer 15

HSV retinitis

Question 16

Symptoms: painless retinitis

Fundoscopy: fluffy or granular retinal lesions located near the retinal vessels and associated hemorrhages

Answer 16

CMV retinitis

Question 17

What is a hepatic hydrothorax? What is the cause?

Answer 17

A pleural effusion usually seen in patients with liver disease thought to be due to small defects in the diaphragm

Question 18

What is the treatment for hepatic hydrothorax?

Answer 18

• Salt restriction
• Diuretic administration
• liver transplant if possible

Question 19

What drug is approved for both the treatment and prevention of AA amyloidosis?

Answer 19

Colchicine

Question 20

What type of study looks at a population’s disease incidence? Prevalence?

Answer 20

• Incidence: cohort

- prevalence: cross sectional

Question 21

What is the treatment for pulmonary nocardiosis? Actinomyces?

Answer 21

• nocardia: TMP-SMX

- actinomyces: penicillin G